Provider Demographics
NPI:1013663533
Name:POLK, LINDSEY (MMT)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:POLK
Suffix:
Gender:F
Credentials:MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9209 BAILEYWICK RD STE 107
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1975
Mailing Address - Country:US
Mailing Address - Phone:984-242-4000
Mailing Address - Fax:
Practice Address - Street 1:9209 BAILEYWICK RD STE 107
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-1975
Practice Address - Country:US
Practice Address - Phone:984-242-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10826225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty